How to Cultivate Resilience like a Starfish

Starfish are masters at letting turmoil wash around them. They are also excellent models of resilience. This short video uses imagery from the sea and provides a strategy to get grounded, steady the breath, and cultivate four key aspects of resilience: purpose, connection, adaptability, and hope.

Become present and let thinking float away as you treat yourself to this opportunity to take a few minutes to care for yourself.

Mental Health Education and Support at School can be Critical

A Brief Overview

  • Alarming statistics indicate the pandemic has worsened behavioral health outcomes for young people. Governor Jay Inslee on March 14, 2021, issued an emergency proclamation declaring children’s mental health to be in crisis.
  • Students eligible for special education services through the federal category of Emotional Disturbance are more than twice as likely as other disabled peers to quit school before graduating.
  • These outcomes make adolescence a critical time for mental health promotion, early identification and intervention. Read on for further information and resources.
  • Seattle Children’s Hospital has a referral helpline. Families can call 833-303-5437, Monday-Friday, 8-5, to connect with a referral specialist. The service is free for families statewide.
  • Help is available 24/7 from the Suicide Prevention Lifeline: 1-800-273-TALK.
  • Text HEAL to 741741 to reach a trained Crisis Text Line counselor.
  • For youth who need support related to LGBTQ issues, the Trevor Projectprovides targeted resources and a helpline: 866-488-7386.
  • A place to connect with other families is a Facebook group called Youth Behavioral Healthcare Advocates (YBHA-WA).
  • Family caregivers can request support and training from A Common Voice, a statewide non-profit staffed with Parent Support Specialists who have lived experience parenting a child with mental illness or behavioral health challenges. Contact Jasmine@acommonvoice.org/253-732-4944.

Full Article

Alarming statistics indicate the COVID-19 pandemic has worsened circumstances for young people who were already struggling to maintain mental health. Washington’s most recent Healthy Youth Survey, from 2018, revealed that 10 percent of high-school students had attempted suicide within the year. Governor Jay Inslee on March 14, 2021, issued an emergency proclamation declaring children’s mental health to be in crisis.

The governor’s order requires schools to provide in-person learning options and directs the Health Care Authority and Department of Health to “immediately begin work on recommendations on how to support the behavioral health needs of our children and youth over the next 6 to 12 months and to address and triage the full spectrum of rising pediatric behavioral health needs.”

The Children and Youth Behavioral Health Work Group (CYBHWG) was created in 2016 by the Legislature (HB 2439) to promote system improvement. CYBHWG supports several advisory groups, including one for Student Behavioral Health and Suicide Prevention. The work groups include representatives from the Legislature, state agencies, health care providers, tribal governments, community health services, and other organizations, as well as parents of children and youth who have received services. Meetings include opportunities for public comment. Meeting schedules and reports are posted on the Health Care Authority (HCA) website.

A press for more school-based services

Advocacy for more school-based mental health services comes from the University of Washington’s SMART Center. SMART stands for School Mental Health Assessment Research and Training. The SMART center in 2020 provided the legislative work group with a report: The Case for School Mental Health. The document includes state and national data that strongly indicate school-based behavioral health services are effective:

“Increased access to mental health services and supports in schools is vital to improving the physical and psychological safety of our students and schools, as well as academic performance and problem-solving skills. Availability of comprehensive school mental health promotes a school culture in which students feel safe to report safety concerns, which is proven to be among the most effective school safety strategies.”

The statewide Student Behavioral Health and Suicide Prevention advisory group has recommended widespread implementation of Multi-Tiered Systems of Support (MTSS). Through MTSS, schools support well-being for all students through school-wide programming and offer higher levels of support based on student need. Social Emotional Learning (SEL) is a key component of an MTSS framework, which also creates a structure for providing Positive Behavioral Interventions and Supports (PBIS) at various levels of need.

The Office of Superintendent of Public Instruction, the guidance agency for Washington schools, prioritized 2021 budget requests to Empower all Schools to Support the Whole Child, including through MTSS. In January, 2021, OSPI was awarded a five-year, $5.3 million grant from the U.S. Department of Education to build regional coaching capacity to support districts in their MTSS implementation. As a local control state, Washington districts determine their own specific policies and procedures.

TIP: Families can ask school and district staff to describe their MTSS framework and how students are receiving support through the various levels/tiers.

Special Education is one pathway for more help

Students may access mental health support through the special education system. Emotional Disturbance is a federal category of disability under the Individuals with Disabilities Education Act (IDEA). Appropriate support can be especially critical for these students: According to the U.S. Office of Special Education Programs (OSEP), students eligible for school-based services under the ED category are twice as likely to drop out of high school before graduating.

Note that a student with a mental health condition could qualify for an IEP under the category of Other Health Impairment (OHI), which captures needs related to various medical diagnoses.

In Washington State, the ED category is referred to as Emotional Behavioral Disability (EBD). If the student’s behavioral health is impaired to a degree that the student is struggling to access school, and the student needs specially designed interventions, then the student may be eligible for an Individualized Education Program (IEP). Keep in mind that academic subjects are only a part of learning in school: Social Emotional Learning (SEL) is part of the core curriculum. 

An educational evaluation determines whether a student has a disability that significantly impacts access to school and whether specially designed instruction and/or related services are needed for the student to receive a Free Appropriate Public Education (FAPE). FAPE is the entitlement of a student eligible for special education services and an IEP team determines how FAPE/educational services are provided to an individual student.

Behavioral health counseling can be part of an IEP

Counseling can be written into an IEP as a related service. When included in a student’s IEP as educationally necessary for FAPE, a school district is responsible to provide and fund those services. School districts can receive reimbursement for 70 percent of the cost of behavioral health services for students who are covered by Medicaid and on an IEP.

A student with a mental health condition who doesn’t qualify for an IEP might be eligible for a Section 504 Plan. A disability that impairs a major life activity triggers Section 504 protections, which include the right to appropriate and individualized accommodations at school. Section 504 is an aspect of the Rehabilitation Act of 1973, a Civil Rights law that protects against disability discrimination. Students with IEPs and 504 plans are protected by Section 504 rights.

Behavioral Health encompasses a wide range of disability conditions, including those related to substance use disorder, that impact a person’s ability to manage behavior. Sometimes students with behavioral health disabilities bump into disciplinary issues at school. Students with identified disabilities have protections in the disciplinary process: PAVE provides a detailed article about student and family rights related to school discipline.

Placement options for students who struggle with behavior

IEP teams determine the program and placement for a student. In accordance with federal law (IDEA), students have a right to FAPE in the Least Restrictive Environment (LRE) to the maximum extent appropriate. That means educational services and supports are designed to help students access their general education classroom first. If they are unable to make meaningful progress there because of their individual circumstances and disability condition, then the IEP team considers more restrictive placement options. See PAVE’s article: Special Education is a Service, Not a Place.

Sometimes the IEP team, which includes family, will determine that in order to receive FAPE a student needs to be placed in a Day Treatment or Residential school. OSPI maintains a list of Non-Public Agencies that districts might pay to support the educational needs of a student.

A precedent-setting court ruling in 2017 was Edmonds v. A.T. The parents of a student with behavioral disabilities filed due process against the Edmonds School District for reimbursement of residential education. The administrative law judge ruled that the district must pay for the residential services because “students cannot be separated from their disabilities.”

Strategies and safety measures for families

With the release of the Healthy Youth Survey in Spring, 2019, the state issued a two-page Guide to Mental Health Information and Resources to provide more detail about the survey and to direct families and school staff toward resources for support.

Included is a list of factors that help youth remain resilient to mental health challenges:

  • Support and encouragement from parents/guardians and other family members, friends, school professionals, and other caring adults
  • Feeling that there are people who believe in them, care about them, and whom they can talk to about important matters
  • Safe communities and learning environments
  • Self-esteem, a sense of control and responsibility, and problem-solving and coping skills
  • Having an outlet for self-expression and participation in various activities

The handout includes tips for parents and other adults supporting teens who feel anxious or depressed:

  • Bond with them: Unconditional love includes clear statements that you value them, and your actions show you want to stay involved in their lives.
  • Talk with teens about their feelings and show you care. Listen to their point of view. Suicidal thinking often comes from a wish to end psychological pain.
  • Help teens learn effective coping strategies and resiliency skills to deal with stress, expectations of others, relationship problems, and challenging life events.
  • Have an evening as a family where everyone creates their own mental health safety plan.
  • Learn about warning signs and where to get help
  • Ask: “Are you thinking about suicide?” Don’t be afraid that talking about it will give them the idea. If you’ve observed any warning signs, chances are they’re already thinking about it.
  • If you own a firearm, keep it secured where a teen could not access it. Lock up medications they shouldn’t have access to.

State options for behavioral health services and support

For Washington children and youth with Medicaid insurance, the highest level of community-based care in behavioral health is provided through Wraparound with Intensive Services (WISe). The WISe program was begun as part of the settlement of a class-action lawsuit, TR v Dreyfus, in which a federal court found that Washington wasn’t providing adequate mental-health services to youth. WISe teams provide a wide range of therapies and supports with a goal to keep the young person out of the hospital.

Young people under 18 who need residential care to meet medical needs may be referred to the Children’s Long-Term Inpatient program: PAVE’s website provides an article about CLIP.

If a person ages 15-40 is newly experiencing psychosis, Washington offers a wraparound-style program called New Journeys. This website link includes access to a referral form.

The Family, Youth and System Partner Round Table (FYSPRT) provides a meeting space for family members and professionals to talk about what’s working and what isn’t working in mental healthcare. FYSPRT groups provide informal networking and can provide ways for families to meet up and support one another under challenging circumstances.

Federal parity laws require insurers to provide coverage for behavioral health services that are equitable to coverage for physical health conditions. The National Health Law Program (NHLP) provides information and advocacy related to behavioral healthcare access and offers handouts to help families know what to expect from their insurance coverage and what to do if they suspect a parity law violation:

Family Initiated Treatment (FIT) is an option in Washington

Youth older than 13 have the right to consent or not consent to any medical treatment in Washington State. Parents and lawmakers throughout 2018-2019 engaged in conversations about how that creates barriers to care for some teens struggling with behavioral health conditions. The Adolescent Behavioral Health Care Access Act (HB 1874), became law in May 2019. PAVE provides an article about the law and its provision for Family Initiated Treatment.  

Places to seek referrals and information

Seattle Children’s Hospital in 2019 launched a referral helpline. Families can call 833-303-5437, Monday-Friday, 8-5, to connect with a referral specialist. The service is for families statewide. In addition to helping to connect families with services, the hospital is gathering data to identify gaps in care.

PAVE’s Family-to-Family Health Information Center provides technical assistance to families navigating health systems related to disability. Click Get Help at wapave.org or call 800-572-7368 for individualized assistance. Family Voices of Washington provides further information and resources.

Key Resources

For information, help during a crisis, emotional support, and referrals:  

  • Suicide Prevention Lifeline (1-800-273-TALK)
  • Text “HEAL” to 741741 to reach a trained Crisis Text Line counselor
  • Trevor Project Lifeline (LGBTQ) (1-866-488-7386)
  • The Washington Recovery Help Line (1-866-789-1511)
  • TeenLink (1-866-833-6546; 6pm-10pm PST)

Further information on mental health and suicide:  

Social Emotional Learning, Part 3: Tools for Regulation and Resiliency

A Brief Overview

  • Children who are taught self-regulation are more resilient and learn better in academics and more. This article describes a few practical tools and techniques that are aspects of Social Emotional Learning (SEL).
  • “Kids do well if they can,” says Ross W. Greene, a child psychologist and author. In a short YouTube video, Greene says, “The biggest favor you can do a challenging kid is to finally, at long last, be the person who figures out what’s getting in his way.”
  • PAVE provides additional articles about Social Emotional Learning.
  • Washington’s Office of Superintendent of Public Instruction (OSPI) provides SEL learning activities for families and educators. OSPI also provides free online SEL training, links to information about SEL state learning standards, and more on the Social and Emotional Learning page of its website: k12.wa.us.

Full Article

When children act out at school, what does the teacher do? The answer depends on the discipline policies of the school, but research indicates that suspending and expelling students is ineffective for improving behavior and can cause harm (NIH.gov).

Social Emotional Learning (SEL) in schools marks a shift toward education that promotes self-regulation, resiliency, problem-solving skills, and more. “Kids do well if they can,” says Ross W. Greene, who explains his statement in a short YouTube video. Greene is a clinical child psychologist and author of the books The Explosive Child, Lost at School, Lost & Found, and Raising Human Beings.

By accepting the logic that kids do well if they can, adults shift away from believing that kids behave only if they “want to” and allows for problem-solving, Greene says: “The biggest favor you can do a challenging kid is to finally, at long last, be the person who figures out what’s getting in the way [of doing well].”

Behavior is communication: “Get curious, not furious”

Adults can consider behavior as a form of communication and seek to understand the function of the behavior. One educator refers to this approach as “Getting Curious (Not Furious) With Students.” In the article, posted to Edutopia.org June 29, 2016, Rebecca Alber says, “When teachers get curious instead of furious, they don’t take the student’s behavior personally, and they don’t act on anger. They respond to student behaviors rather than react to them.”

Alber lists the primary benefits to schools when they promote SEL and trauma-informed approaches to discipline:

  • Improved student academic achievement
  • Less student absences, detentions, and suspensions
  • Reduction of stress for staff and students and less bullying and harassment
  • Improved teacher sense of job satisfaction and safety

Tip: Request a Functional Behavior Assessment

A Functional Behavioral Assessment (FBA) may be necessary in circumstances where behavior consistently impedes learning. Schools can use FBA data to build an individualized Behavior Intervention Plan (BIP). A BIP may support an Individualized Education Program (IEP) or could be a stand-alone plan for any student.

When using positive behavior support strategies, adults can avoid judging behavior with labels such as bad, non-compliant, defiant, uncooperative, etc. Researchers have found that those labels often refer to adult perception and frustration about what is happening more than they explain what a child may be trying to express.

Family caregivers might read through a student’s Individualized Education Program (IEP), a behavior plan, disciplinary referrals, or other notes from the school to notice what type of language is being used to describe what’s happening. Requesting a meeting to discuss an FBA and/or strategy for SEL skill-building is an option.

Raw moments are opportunities to teach from the heart

Heather T. Forbes, author of Help for Billy, is among professionals designing new ways to help children cope and learn. Emotional instruction is crucial, argues Forbes, whose website, Beyond Consequences, shares Trauma-Informed Solutions for parents, schools, and other professionals.

“It is in the moments when your child or student is most ‘raw’ and the most dysregulated [out of control],” Forbes writes, “that you are being presented with an opportunity to create change and healing. It takes interacting from not just a new perspective but from an entirely new paradigm centered in the heart.”

In an article, Teaching Trauma in the Classroom, Forbes concludes: “These children’s issues are not behavioral. They are regulatory. Working at the level of regulation, relationship, and emotional safety addresses more deeply critical forces within these children that go far beyond the exchanges of language, choices, stars and sticker charts.”

Regulation starts in the brain

SEL supports are informed by brain science. OSPI provides a free downloadable handbook, The Heart of Learning and Teaching: Compassion, Resiliency, and Academic Success. Included in Chapter One is a list of the brain regions affected by trauma. Understanding the amygdala as a center for fear, for example, can be critical for designing strategies to manage meltdowns. “Overstimulation of the amygdala…activates fear centers in the brain and results in behaviors consistent with anxiety, hyperarousal and hypervigilance,” the page informs.

Writing for Edutopia, Rebecca Alber recommends that teachers learn to understand and recognize impacts of trauma and to understand that apparent refusal to comply might actually be a trauma-based response.

“When we ask students to do high-level tasks, such as problem solving or design thinking,” Alber says, “it’s nearly impossible if they are in a triggered state of fight, flight, or freeze. This trauma state may look like defiance or anger, and we may perceive this refusal as choice, but it is not necessarily so.”

Use Your Words

Some teachers are turning directly to scientists for advice. Dan Siegel, a well-known neurobiologist and author, offers tips through his agency, Mindsight. Mindsight teaches how to “name and tame” emotions to keep from getting overwhelmed. For example, Siegel suggests learning the difference between these two sentences:

  1. I am sad.
  2. I feel sad.

The first statement “is a kind of limited self-definition,” Siegel argues, while the second statement “suggests the ability to recognize and acknowledge a feeling, without being consumed by it.”

Encourage rather than simply praise

Word choice can be critical in trauma-informed instruction. Jody McVittie, a pediatrician who started Sound Discipline, based in Seattle, gives workshops for parents and teachers. She talks about the difference between praise and encouragement in a training called Building Resiliency. Instead of saying “Great Job,” which can trigger an emotional response but may not reinforce learning, a teacher or parent might say instead:

  • “I noticed that you wrote all of the letters of your name on the line and it was really easy to read.”
  • “I appreciate that you asked some insightful questions during our discussion about the Constitution today.”
  • “I know you can write a creative description of the book you read.”

The more specific the encouragement, McVittie says, the more the student will be encouraged to keep working on that expected behavior. Another of McVittie’s key concepts is “connection before correction” to help teachers create helpful relationships with students. An example she uses in her trainings:

A teenaged student tossed a soda can from across the room during class. A trauma-trained teacher pointed to the hallway, and the boy joined her there. Instead of directing him to the office, the teacher explained that she really enjoyed having him in class. She said that he contributed valuable questions. Then she asked why he thought he was in the hallway. He said it was because he threw the soda can. She asked, “What’s your plan?” His answer included apologies and decision-making about how to avoid the mistake again.

This story certainly could have ended differently, and McVittie encourages educators and parents to avoid a “Dignity Double-Bind,” where children experience shame instead of problem-solving:

“Make the child think,” she says, “by showing respect instead of giving orders to obey.”

A Self-Regulation Strategy for Right Now

Sometimes grace starts with self-care. Following is a breathing practice you can use right now to help your nervous system regulate. If you prefer, you can watch a short video from PAVE that demonstrates this technique: Stop and Settle with Five-Fingers Breath.

You will be breathing evenly as you trace the outline of your hand, giving your eyes and your mind something to focus on while you control your breath.

  • Hold up one hand, with your palm facing you.
  • Place the first finger of your other hand onto the bottom of your thumb.
  • As you breathe in, slide your finger up to the top of your thumb.
  • Breathing out, slide your finger into the valley between your thumb and first finger.
  • Breathing in, slide up your first finger. Breathing out, slide down the other side.
  • Continue following your breath up and down all your fingers.
  • When you breathe out down the outside edge of your pinkie, continue to exhale until you reach your elbow.
  • Notice how you feel. Allow your breath to find a natural pattern.

Now that you’ve learned this technique, you can share it with other family members!